Impact of a Standardized Hydroxyurea Dose Regimen for Extreme Thrombocytosis in Children after Pancreatectomy with Islet Autotransplantation

Total pancreatectomy with islet autotransplantation (TPIAT) is a therapeutic option for debilitating acute recurrent or chronic pancreatitis. While postoperative diabetes and pain outcomes are well-described in these patients, the hematologic outcomes have not been thoroughly examined. Specifically, the natural history and optimal management of the nearly universal post-IAT extreme thrombocytosis (platelets >1000 K/μL) beginning within days of surgery and often lasting for months remains enigmatic. Concern for thrombosis risk from the extreme thrombocytosis has prompted empiric, widely-employed pharmacologic alteration of platelet count (hydroxyurea) and function (aspirin, ASA); however, the optimal dosing strategy and efficacy of these therapies after IAT are poorly characterized.Patients who underwent TPIAT (n=28) or subtotal pancreatectomy with islet autotransplantation (n=2), all with splenectomy, at Cincinnati Children's Hospital Medical Center between January 1, 2015 and April 30, 2018 were retrospectively reviewed. Hydroxyurea management strategies, hematologic trends, and hydroxyurea side effects were evaluated.The mean age of the patients was 12.3 years (range 3-19 years). All started ASA on post-operative day (POD) 2-3 at a median daily dose of 2 mg/kg [Interquartile Range (IQR) 1.7-2.13). This was continued until hydroxyurea was discontinued and platelet count remained normal for 4 weeks. All received prophylactic heparin and later enoxaparin post-operatively...
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Poster II Source Type: research